Wolfe Frederick, Freundlich Bruce, Straus Walter L
National Data Bank for Rheumatic Diseases, Wichita, Kansas, USA.
J Rheumatol. 2003 Jan;30(1):36-40.
To determine whether the risk for cardiovascular and/or cerebrovascular disease (CCVD) is increased in rheumatoid arthritis (RA) compared to osteoarthritis (OA), a disease not known to be associated with increased CCVD.
In July 1999, a survey was administered to a sample of 11,572 patients (9,093 with RA, 2479 with OA) from the practices of 709 US community-based rheumatologists. Patients reported past and current myocardial infarction (MI), stroke (cerebrovascular accident, CVA), and lifetime congestive heart failure (CHF), and also provided demographic and clinical information. To estimate the impact of recall bias, medical records were obtained and reviewed for a 50% random sample of the patients reporting CCVD events, with 95% of CCVD reported events confirmed by record review.
Patients with RA and OA differed across all demographic variables. In addition, each variable was significantly associated with MI, CHF, and CVA outcomes. Logistic regression was performed to measure the associations of these outcomes with RA as compared to OA, adjusting for age, sex, education level, smoking, income, hypertension, and body mass index. Compared with OA, patients with RA had the following increased risks: for current MI [odds ratio (OR), 95% confidence interval (95% CI)] 2.14, (1.48, 3.09), lifetime MI 1.28 (1.24, 1.33), CHF 1.43 (1.28, 1.59), current CVA 1.70 (1.29, 2.24), and lifetime CVA 1.005 (0.931, 1.196). The adjusted current and lifetime prevalences of MI were 0.76 and 4.14% for RA versus 0.35 and 3.23% respectively for OA; 0.86 and 3.02% (RA) versus 0.50 and 3.03% (OA) for CVA; and for lifetime CHF, 2.34% (RA) versus 1.64% (OA), respectively.
RA is associated with an increased risk for CCVD morbidity due to MI, CHF, and probably for CVA, and may be an independent risk factor for these events.
确定类风湿关节炎（RA）患者发生心血管和/或脑血管疾病（CCVD）的风险是否高于骨关节炎（OA），后者是一种已知与CCVD风险增加无关的疾病。
1999年7月，对来自美国709位社区风湿病专科医生诊所的11572例患者（9093例RA患者，2479例OA患者）进行了一项调查。患者报告既往及当前的心肌梗死（MI）、中风（脑血管意外，CVA）和终生充血性心力衰竭（CHF）情况，并提供人口统计学和临床信息。为评估回忆偏倚的影响，获取并审查了报告CCVD事件患者的50%随机样本的病历，95%的CCVD报告事件经病历审查得到证实。
RA患者和OA患者在所有人口统计学变量上均存在差异。此外，每个变量均与MI、CHF和CVA结局显著相关。进行逻辑回归分析以测量这些结局与RA（相对于OA）的关联，并对年龄、性别、教育水平、吸烟、收入、高血压和体重指数进行校正。与OA相比，RA患者有以下风险增加：当前MI[比值比（OR），95%置信区间（95%CI）]2.14（1.48，3.09），终生MI 1.28（1.24，1.33），CHF 1.43（1.28，1.59），当前CVA 1.70（1.29，2.24），终生CVA 1.005（0.931，1.196）。校正后的当前和终生MI患病率在RA患者中分别为0.76%和4.14%，而在OA患者中分别为0.35%和3.23%；CVA分别为0.86%和3.02%（RA）对0.50%和3.03%（OA）；终生CHF在RA患者中为2.34%，在OA患者中为1.64%。
RA与因MI、CHF以及可能因CVA导致的CCVD发病风险增加相关，可能是这些事件的独立危险因素。
